Plantar Fasciitis
Plantar Fasciitis (PF), in simplest terms, is inflammation of the plantar (bottom of the foot) fascia (a specialized connective tissue overlying muscles).
In order to understand the definition of 'true PF', it is first necessary to appreciate what it is, and what it is not. The term PF has been used erroneously by many people, for many years.medical professionals included! The most common misuse of the term PF occurs when describing, discussing, or diagnosing classic heel pain. PF is not heel pain, and heel pain is not PF.
The type of neuropathy that Dr. Tompkins has determined you have is called diabetic peripheral neuropathy . This is a disease process that affects the nerves in your arms/hands and legs/feet caused by the long-term effects of diabetes mellitus. The term process is used because peripheral neuropathy is a progressive disease that slowly causes the nerve(s) to function improperly. Early symptoms of neuropathy often vary and can demonstrate degrees of numbness, tingling, and burning. Often time's patients will describe cold or warm sensations, constrictive feelings, or a feeling of their socks being "balled-up" in their shoes. This process of developing neuropathy varies with each individual person, but many times is related to poor diabetic management and blood sugar control.
There is a very long list of potential causes for pain which occurs in the heel; however, there is one particular condition which makes-up the vast, vast majority of people who suffer from chronic pain in their heels. This condition is called heel spur syndrome (HSS). True HSS is comprised of inferior calcaneal bursitis (inflammation of the protective bursa under the heel spur), calcaneal periostitis (inflammation of the tissue surrounding the heel spur), and insertional plantar fasciitis (inflammation of the attachment of the fascia to the heel spur).
'True PF' differs from 'true HSS' in that it only exists as an inflammation of the central and/or medial slip(s) of the plantar fascia in the arch region of the foot (not at the heel). This is an important distinction, as the correct diagnosis is vital to appropriate treatment.
For more information regarding HSS, please visit the Common Foot Problems on heel pain.
FPF occurs far less frequently than HSS, and unfortunately, many times these two conditions are synonymously used. Again, the primary difference between PF and HSS, is the location of the pain.the arch vs. the heel, respectively. PF can occur after periods of rest, especially the first few steps in the morning. However, it commonly occurs after periods of increased activity and/or exercise. Patients with persistent PF, often develop compensatory-type pain and problems in other areas of the same foot, the opposite foot, and/or with the knees, hips, and back.
Treatment
The hallmark treatments for PF are stretching and support. Stretching of the Gastroc-complex (calf muscles) is paramount to eliminating the recurrent inflammation associated with PF. Support can come from a variety of sources. Something as simple as a more supportive shoe works well for mild forms of PF. There are also many varieties of OTC arch supports available at sporting goods stores and pharmacies. Mild to moderate degrees of PF tend to respond to this type of support.
The mainstay of moderate to severe forms of PF is custom molded biomechanical functional orthotics (BFO). BFO are best prescribed by a podiatric physician with special training and expertise in the field of biomechanics. For best results, the fabrication of these devices involves a thorough biomechanical examination, a gait analysis, and plaster casts taken of the feet in neutral position. There are numerous labs throughout the country where the casts are then sent for the manufacture of the BFO devices.
I
currently use PAL Health Systems
Laboratories for athletes and very active people. Recent new technologies
include computerized gait analysis and 3-D scanning offered by such companies
as Footmax .
It is important to remember that when it comes to orthotics or inserts.. you get what you pay for! BFO devices prescribed by a podiatric physician are very expensive; however, they work extremely well in resistant cases of PF. Many health insurance companies cover the cost of BFO when the prescription is written by a podiatric physician.
For
additional information regarding podiatric biomechanics, please visit the Common
Foot Problems, metatarsalgia
section.
In
addition, night-splints, oral and injectible anti-inflammatory medications, and
physical therapy are used in the treatment of moderate to severe cases of PF.
Severe cases of PF that have been resistant to ALL the previous conservative
treatments, tend to respond to a relatively minor surgical procedure called a
plantar fasciotomy. This is a 20 minute, out-patient type of procedure, performed
with mild twilight/local sedation, and involves the transection of the medial
2/3's (inside portion) of the plantar fascial structures. Healing times vary,
but routinely, patients are back into normal activity and shoes within 4-6 weeks,
utilizing a post-operative surgical shoe.
For additional information regarding podiatric biomechanics, please visit
the Common Foot Problems section: Metatarsalgia
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